某醫學中心護理人員接受高級心臟救命術課程自評執行急救能力之研究

A Study ofMedical Center Nurse 冶Self-assessment in Performance of Advanced Cardiac Life Support Skills

護理人員在醫療團隊中常常是病人發生突發狀況，需要急救的目擊者或者為最先到達的專業人員。因此，護理人員是否有能力處理緊急狀況，往往關係著病人的預後。本研究目的在探討北部某醫學中心一年內曾接受高級心臟救命術課程之護理人員，自評執行急救能力之狀況，及不同基本屬性對其自評執行急救能力之影響。採橫斷性調查相關性研究，以Cronbach's α為.95的自擬「護理人員自我評估執行急救能力量表」進行資料收集，發出223份問卷，回收187份，有效問卷數為176份，有效問卷回收率達78.9%。護理人員自我評估執行急救能力整體平均得分為4.13分（SD=0.46），另利用探索式因素分析建構出六個因素命名為：呼吸道及循環之維持、急救評估及初步處置、團隊合作和異常處理、病患與家屬之溝通協調、護理急救角色功能之展現以及異常心律之判讀及處置，合計共解釋61.72%變異量。年齡愈大、護理進階層級較高、臨床工作年資愈久，急救能力得分顯著較高。建議醫院管理者針對年齡較小、初階護理層級、工作年資較短的新手醫療人員，規畫並安排其接受急救相關訓練課程，若能將護理進階訓練課程目標與本研究發現護理人員所應具備的急救能力結合，搭配相關認證制度，將有效提昇對病人之服務品質。As nurses often discover patients who have a critical situation at first, they should be trained and be able to perform resuscitation skills adequately. This study aims to investigate medical center nurses who received advanced cardiac life support courses within a year and their self-assessment of the performance of ACLS skills, and to examine the association between demographic data and their self-evaluated ability of emergency.This descriptive and correlational study used a cross-sectional survey of clinical nurses from a medical center in northern Taiwan. We use ”nurse's self-assessment and performance of ACLS skills in medical center” scale as an instrument. Cronbach's α was .95. The study distributed 223 questionnaires of which 187 questionnaires were returned, giving an effective return rate of 94.1%. The mean self-rating score of ACLS competence was 4.13 (SD = 0.46) for all subjects. By using item analysis and explorations as well as exploratory factor analysis, they were extracted into six factors, named for: ”competence in proper care of respiratory and cardiovascular systems, ” ”competence in pre-ACLS assessment and initial treatment of patients, ” ”competence in teamwork and exception handling, ” ”competence in communication with patients and their families, ” ”competence in ACLS nursing, ” and ”competence in nursing diagnosis and treatment of abnormal heart rhythm.” Six factors in total explained 61.72% of the variance. Subjects who were older, possessing higher level qualifications on the nursing clinical ladder, and who were more experienced in clinical nursing practice were found to achieve significantly higher mean scores in the self-assessment of ACLS competence.Hospital management should provide effective ACLS training for younger, elementary level qualifications on the nursing clinical ladder. In addition, advanced nursing training should include ACLS certification to enhance the overall quality of nursing care.